Process an Invoice
For Commercial Lines (Smart PDF)
Completed by
*
Enter Acc. Manager / Producer
Agency Name
*
Enter the agency name, FYI this does not have an affect on automatic routing
Agency Info:
Today Date
*
-
Month
-
Day
Year
Date
Invoice being issued for
*
Please Select
New Policy
Existing Policy
Enter the Agency Name (DBA)
*
Enter the Agency Phone Number
*
Agency Street Address
Agency City Address
Agency State Address
Agency Zip Address
Enter the Agency Fax Number
*
Enter the Agency E-mail
*
Client Info:
Is the Insured a legal entity such as a LLC or Corporation or are they Individual people/sole proprietor
*
Please Select
Legal Entity (LLC, INC, ETC)
Individual people
Note: All the names will show on the evidence in the named insured area (box)
What is the name of the Business entity. This must match 100% exactly as it appears on the policy
*
IMPORTANT: This must match 100% exactly as it appears on the policy declarations
How many named insured will there be in the policy, therefore showing on the Invoice. (Must match the Policy)
*
Please Select
1
2
3
Note: All the names will show on the evidence in the named insured area (box)
What is the name of the 1st Named Insured
*
IMPORTANT: This must match 100% exactly as it appears on the policy declarations
What is the name of the 2nd Named Insured
*
IMPORTANT: This must match 100% exactly as it appears on the policy declarations
What is the name of the 3rd Named Insured
*
IMPORTANT: This must match 100% exactly as it appears on the policy declarations
Does the named insured use a DBA
*
Please Select
Yes
No
Note: This DBA would be how the business is advertised to the public unless they use the entity name only
What is the name of the DBA.
*
IMPORTANT: Make sure to enter the DBA name as it appears on all publications
mapping-DBA name
*
Will the DBA need to appear on COI
*
Please Select
Yes
No
Note: This DBA would be how the business is advertised to the public unless they use the entity name only
Named Insured Address
*
Address
Street
City
State
Zip
Policy Information:
How many policies are we going to invoice for
*
Please Select
1
2
3
4
5
What is the line of Business for the 1st policy
*
Please Select
Commercial Package
Commercial Auto
Commercial Flood
Commercial Earthquake
Commercial General Liability
Crime Coverage
Worker's Compensation
Professional Liability
EPLI
Directors and Officers
Errors and Omission
Fiduciary
What is the policy or quote number for the 1st policy
*
What is the cost of the 1st policy that includes premium + taxes + BK Fee
*
Make sure to include all taxes and surcharges including our Agency Broker Fee (If any)
What is the line of Business for the 2nd policy
*
Please Select
Commercial Package
Commercial Auto
Commercial Flood
Commercial Earthquake
Commercial General Liability
Crime Coverage
Worker's Compensation
Professional Liability
EPLI
Directors and Officers
Errors and Omission
Fiduciary
What is the policy or quote number for the 2nd policy
*
What is the cost of the 2nd policy that includes premium + taxes + BK Fee
*
Make sure to include all taxes and surcharges including our Agency Broker Fee (If any)
What is the line of Business for the 3rd policy
*
Please Select
Commercial Package
Commercial Auto
Commercial Flood
Commercial Earthquake
Commercial General Liability
Crime Coverage
Worker's Compensation
Professional Liability
EPLI
Directors and Officers
Errors and Omission
Fiduciary
What is the policy or quote number for the 3rd policy
*
What is the cost of the 3rd policy that includes premium + taxes + BK Fee
*
Make sure to include all taxes and surcharges including our Agency Broker Fee (If any)
What is the line of Business for the 4th policy
*
Please Select
Commercial Package
Commercial Auto
Commercial Flood
Commercial Earthquake
Commercial General Liability
Crime Coverage
Worker's Compensation
Professional Liability
EPLI
Directors and Officers
Errors and Omission
Fiduciary
What is the policy or quote number for the 4th policy
*
What is the cost of the 4th policy that includes premium + taxes + BK Fee
*
Make sure to include all taxes and surcharges including our Agency Broker Fee (If any)
What is the line of Business for the 5th policy
*
Please Select
Commercial Package
Commercial Auto
Commercial Flood
Commercial Earthquake
Commercial General Liability
Crime Coverage
Worker's Compensation
Professional Liability
EPLI
Directors and Officers
Errors and Omission
Fiduciary
What is the policy or quote number for the 5th policy
*
What is the cost of the 5th policy that includes premium + taxes + BK Fee
*
Make sure to include all taxes and surcharges including our Agency Broker Fee (If any)
Total cost for all policies.
*
Bill for this amount on the invoice.
*
Please Select
Yes
No
This will appear as the amount due on the invoice
Enter the amount you wan't to invoice.
*
This will appear as the amount due on the invoice
Billing Party:
What is the Due Date
*
Bill to:
*
Enter the name of the company that we are billing
Attention to:
*
Enter the name of the person or department you want to bill. Example: Attention Escrow Dept.
Loan/Account Number:
Enter the loan number if applicable otherwise leave blank
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